The crux of criteria

Without funding it is difficult (not impossible) to run Exercise on Referral (EoR) schemes and without results we won't get funding. Data, is therefore, quite literally our lifeblood.

In order to get results we need appropriate criteria to assess patients; before, during and after EoR programmes. This is the crux of everything we do. But how do we develop appropriate criteria when there is so much confusion over what an EoR programme is nowadays?

Traditional EoR schemes were developed to increase activity levels, and this is what our ‘success’ is measured on. There are other essential programmes for people with specific medical conditions, such as cancer, diabetes or cardiac rehab but these may have different aims from EoR, which is or at least should be measured on inactive people becoming moderately active.

There has definitely been a shift with many schemes being commissioned on the basis of one or more medical conditions, rather than focusing on an inactive person seeking to become more active.

We need to consider the implications from commissioners who state that a referral can exist if there is a minimum of one medical condition without mention of their current activity levels, their desire to change and whether the offer ‘fits’ the person referred.

This issue is all down to patient recruitment. First, this is a question for the referrer: Have they checked the patient’s activity levels before referring? Second, one for the scheme: have they checked the patient’s activity levels on point of referral? Often schemes feel obliged to take inappropriate people because they have been referred.

Are we doing enough to recruit the right people to our EOR programmes? Bear in mind that every inappropriate person who goes through the scheme takes the place of an appropriate person, and also has an impact on funding. Fundamentally we need to work with inactive people who have a desire to change.

How do we tackle this? My view is that we should tighten up the access to EoR schemes to not only include the presence of a medical condition but to also consider the current activity level and their desire to change. If someone is already meeting activity guidelines does the presence of a singular medical condition instantly allows access to EoR?

Our own experience of running EOR schemes was that we had to be really strict about pre-screening. If participants were already active we made sure they knew they didn’t need us and could go into mainstream activities instead. Here, trained instructors could integrate them appropriately within the gym and/or classes. Our service had an aim to move people from an inactive status to an active status. If we started with people that were already active we would have shot ourselves in the foot and place the whole service at risk.

Ultimately to gain the ‘success’ our EOR schemes so richly deserve, we need to reconsider inclusion criteria. Without the essential data to do this we simply can’t demonstrate how effective EOR programmes and won’t receive the funding we need.